Abordagem endovascular de lesão de aorta torácica penetrante - relato de caso / Endovascular treatment of penetrating thoracic aorta injury - case report

Resumo O cenário atual do trauma por causas violentas tem apresentado um elevado número de casos. Entre eles, a lesão de aorta torácica por trauma penetrante é uma condição de elevada morbimortalidade que exige diagnóstico adequado e que, nos últimos anos, tem sido corrigida com procedimentos endovasculares. Essa modalidade de tratamento se mostra mais segura, com menor número de complicações em relação ao procedimento cirúrgico aberto. Após a realização da abordagem endovascular, há necessidade de acompanhamento contínuo, que visa monitorar as condições de saúde do paciente e corrigir possíveis complicações relacionadas ao procedimento. O objetivo deste artigo é relatar um caso de traumatismo penetrante de aorta torácica, tratado por via endovascular, visto que a literatura aborda predominantemente as lesões por trauma contuso.

Abstract In the current scenario, traumas with violent causes are responsible for large numbers of cases. Among these, thoracic aorta injury caused by penetrating trauma is a cause of elevated morbidity and mortality, demanding adequate diagnosis, and can now often be repaired using endovascular procedures. This treatment method has proven to be safer, with a lower rate of complications than open surgical procedures. After endovascular repair, it is necessary to conduct continuous monitoring of the patient's health and correct any complications related to the procedure that may emerge. The objective of this article is to describe a case of penetrating trauma of the thoracic aorta that was treated endovascularly, since the literature predominantly covers blunt trauma injuries.

Self-inflicted trans-oral intracranial stab wound.

BACKGROUND: Intracranial stab wounds are low-velocity, penetrating injuries to the brain and fatality and outcome significantly depend on route, depth and location of cranial penetration. Due to the effective barrier provided by the adult calvarium, most injuries occur through the orbitae or temporal regions where bony layers are thin. Self-inflicted intracranial stab wounds are an even rarer form of traumatic brain injury, with common entry points being the orbital space and the nose. Intracranial brainstem injuries mostly result in death, with reported penetration areas being the pons or midbrain. CASE: The following report reviews a first reported case of self-inflicted intracranial stabbing via a trans-oral route with lesions to the medulla oblongata and cerebellum. Unlike previous cases of low velocity penetrating injuries to the brainstem, the patient underwent full neurologic recovery after manual knife removal and intensive rehabilitation. CONCLUSION: Self-inflicted transcranial injuries have been mentioned only briefly and sporadically in the literature. This article highlights a rare case of self-inflicted intracranial stabbing with a not yet reported entry route and brainstem lesion. Unlike the other fatal outcomes associated with such injuries, the patient underwent full neurological and functional recovery through a comprehensive approach that included intensive rehabilitation.

[Muscle injuries: diagnostics and treatments]. / Muskelverletzungen: Diagnostik und Behandlungen.

Muscle injuries are common in sports. They are usually caused by either acute (mostly eccentric mechanisms) or chronic overloading with a lack of muscle coordination. They present in clinical practice as bruises and muscle sprains. Due to the rigours of a modern society and the high economic cost of time off work, an effective treatment needs to be employed. The key to an optimised therapy rests in the appropriate timing between immobilisation and mobilisation. The interval to muscle repair might be shortened by certain adjuvant therapies. In doing so, it is important that no physiological phases of wound healing are overlooked. Muscle healing can be accelerated by externally induced higher metabolic turnover. Surgical therapy is sometimes necessary in selected cases and in serious injuries.

Brown-Séquard-plus syndrome because of penetrating trauma in children.

Brown-Séquard syndrome is an uncommon condition involving incomplete spinal cord injury, with ipsilateral motor and proprioception loss, contralateral pain, and decreased temperature. Brown-Séquard-plus syndrome is associated with additional neurologic findings involving the eyes, bowel, or bladder. We describe an adolescent with Brown-Séquard-plus syndrome attributable to a stab injury. Our patient's clinical features of spinal and neurogenic shock overlapped at presentation. He was managed with high-dose steroids, along with intense physiotherapy and rehabilitation, resulting in good neurologic recovery. Appropriate medical (and surgical, when indicated) management usually results in good to complete recovery of neurologic function, depending on the level and grade of injury. With the increasing incidence of gunshot wounds and stab injuries in children, pediatricians, including pediatric neurologists and emergency physicians, are more likely to encounter these types of spinal cord injuries in children.

Effect of penetrating trunk trauma on the recovery of adult survivors: a pilot study.

Gunshot and/or stab wounds to the trunk are injuries seen in South African hospitals. Patients are managed in the intensive care unit. Prolonged mechanical ventilation with immobilization results in some degree of muscle dysfunction. Our goal was to determine if patients recover adequately spontaneously following critical illness. No formal rehabilitation programmes exist in South Africa for these patients following discharge. A prospective, observational study was conducted. Patients were recruited from three ICUs in Johannesburg. Lung function tests, dynamometry, quality of life, 6-minute-walk, and oxygen uptake tests were performed over 6 months following discharge from the hospital. The control group consisted of existing data for healthy volunteers. Distance walked during 6-minute-walk test was significantly reduced for the study group compared to the control group (1 month [p = 0.00251]; 6 months [p = 0.0355]). At 1 month there was a significant reduction in quadriceps and triceps strength for the study group compared to the control group (p = 0.0089; p = 0.0246, respectively). Quadriceps strength remained significantly reduced for the study group (3 months [p = 0.0489]). No difference in muscle strength was detected between the groups at 6 months. Actual and predicted residual volumes differed significantly for the study group (1 month [p = 0.0034]; 6 months [p = 0.0157]). A trend of muscle weakness (to 3 months), poor exercise capacity, and abnormal lung volumes was identified. A formal rehabilitation programme may be needed to address these disabilities.

Hospitalization and discharge outcome of trauma patients sustaining sciatic nerve or sciatic branch injuries.

This study determined the number and severity of injuries, surgeries, and/or other complications and their impact on the acute hospital course of a series of 15 patients sustaining unilateral traumatic sciatic nerve or sciatic branch injuries. Outcome measures studied were length of stay, time to ambulate independently from admission, starting time for physical therapy, and number of physical therapy sessions. Median length of stay (LOS) and time to independent ambulation with assistive devices from admission were 12 and 8 days, respectively. Seven patients required fasciotomy, five required vascular repair, and five sustained fractures of the involved limb. Patients needing a fasciotomy had a significantly longer LOS (P < 0.002) and time to ambulate independently (P < 0.001), started physical therapy later (P < 0.006), and required more therapy sessions (P < 0.007) before independent ambulation was achieved. Patients with a vascular repair had a significantly longer LOS (P < 0.049) and time to ambulate independently (P < 0.012). These patients trended toward starting physical therapy later (P < 0.063) and requiring more therapy sessions (P < 0.109) before independent ambulation was achieved. The presence of a fracture in the involved limb did not affect outcome variables. The level and severity of nerve injuries were variable; therefore, their effects on LOS and ambulation could not be determined. These findings suggest that fasciotomies and vascular repairs but not fractures adversely affect the acute LOS, time to ambulate independently, start of physical therapy, and number of physical therapy sessions in trauma patients with sciatic nerve or sciatic branch injury. This information may be useful to the consulting physiatrist.

Cola de fibrina em perfuraçäo corneana experimental em cäo / Experimental use of fibrin glue to seal corneal perforations

Usou-se cola de fibrina para tamponar 10 córneas de cäo após trepanaçäo perfurante e retirada do botäo central 3mm de diâmetro. A evoluçäo mostrou assimilaçäo da cola aplicada pela córnea, transformando a cola em cicatriz, a qual vedou eficientemente as córneas, ficando todas as câmaras anteriores profundas, além de näo houve sinéquia anterior com neovasos provavelmente trazidos pela íris na regiäo colada, fato que talvez existisse em menor quantidade se tivesse usado visco-elástico para encher a câmara anterior antes da colagem. Esta cola oferece grande potencial de aplicaçäo em vários tipos de perfuraçöes e vazamentos de líquido intraocular tanto na córnea como na esclera

Cianoacrilato em perfuraçäo corneana pós-injeçäo de silicone intra-ocular: relato de 1 caso / Cyanoacrylate adhesive in the treatment of corneal perforation after silicone oil injection: a case report

Descreve-se o emprego de cola sintética (cianoacrilato) para tamponar perfuraçäo corneana central após vitrectomia via pars plana com injeçäo de silicone intra-ocular em paciente com hipotensäo severa, decorrente de trauma ocular penetrante. Discutem-se os possíveis mecanismos desencadeantes desta rara complicaçäo relacionada ao uso do óleo de silicone